When Kanyarin Ketsuwan tells you she's been battling obesity practically her whole life, she's not being over-dramatic or indulging in exaggeration. By the time she entered her teens she'd already graduated to the XXL end of the clothes rack and was feeling increasingly frustrated and gloomy because her size was preventing her from doing things she wanted to do and limiting the places she could go.
"I'd have loved to get all dressed up, sling on a pair of high-heels and go out on the town with friends. But I was much too shy about how I looked," recalled Kanyarin, who at 1.5m tall, is a bit below average height.
"The first thing people usually noticed about me was my weight," said the Nakhon Si Thammarat native who has retained her distinctive southern accent.
She put most of the blame for all those unwanted kilogrammes on a diet high in carbohydrates. Every day, she told Life, she would have several large meals. At each sitting she would get through at least one and often two heaped plates of rice.
"Southern curries are my favourite dish, you see, but they're famous for being intensely hot. So I'd need to have lots of rice to soak up all the spicy sauce."
After years of gorging on this starchy fare, Kanyarin was registering 75kg on the scales and was feeling anxious about her future as she headed towards a milestone birthday _ the big three-oh.
A relatively young age, but even light physical exertion, she said, had already become a real effort. She was finding it harder and harder to carry out routine tasks like keeping the house clean and doing the grocery shopping; even climbing the stairs in her second-storey home was a struggle.
Things went from bad to worse when her blood pressure and cholesterol levels shot above the normal range. But what worried her most was the adverse impact on her career.
"Projecting a good image is very important in my line of work," said the professional wedding planner, now 37, who also owns a photo studio catering to newlyweds. "I used to wonder whether my weight was making a bad impression on prospective clients. But being so fat also meant that I had to put a lot more effort into simply getting through a day's work."
Well aware of her problem by this stage, Kanyarin had already tried, without success, every weight-loss technique on the market, from diet and exercise programmes to various supplements and pills that purport to help one shed fat painlessly. She was a loyal customer of the country's leading weight-loss and aesthetic institute. And she'd even summoned up the courage to consult a doctor about liposuction, only to be told that the procedure wouldn't work in her case.
''Losing weight is so hard. I joined a gym, but I wasn't able to do more than about five minutes on the treadmill before I started feeling tired. So I called it quits and ended up going home and having a huge meal afterwards!''
Finally, after her weight had crept up to 84kg, Kanyarin realised she'd have to resort to the only option she hadn't yet tried: surgery. She did so knowing full well that it was no miracle cure, that the road to permanent slimness after surgery is by no means an easy one.
Kanyarin's is a classic case of a person whose life has been totally overshadowed by her inability to control her weight. And she is no longer a member of a small minority. Obesity is now a growing public health issue in this country.
According to the Ministry of Health, approximately 10.2 million Thais were classified as being obese in 2007, the most recent year for which statistics are available, with just under one-third of that figure living in urban areas. A staggering 35% of people above the age of 35 were defined as obese.
If left untreated, obesity can give rise to a whole range of health problems, some potentially fatal: sleep apnea, cardiovascular and heart disease, type II diabetes, kidney disease, hypertension and various cancers.
As a last resort, morbidly obese people often have to undergo bariatric surgery _ the general term for a variety of surgical procedures performed on patients who are grossly overweight.
Dr Sutdhachit Linananda, a surgeon and senior consultant at Phramongkutklao College of Medicine in Bangkok, said bariatric surgery is usually only performed on someone for whom other approaches (dieting, exercise regimes, etc) have failed or on patients with serious weight-related health problems.
While ''most Thai people still consider weight-loss surgery to be a cosmetic procedure'', he pointed out that this kind of surgical intervention can actually prolong lifespan and improve the patient's quality of life. The goal, Dr Sutdhachit explained, is to physically alter the patient's digestive system to restrict how much he/she can eat and/or decrease the absorption of nutrients.
''These surgical procedures are not magical remedies. They are just tools to change a patient's lifestyle and eating habits.'' he stressed.
The cost of such an operation is in the region of 200,000 to 250,000 baht if it is carried out in a state-run hospital.
To prevent regression, it is vital that patients have the will-power to adhere to a comprehensive, lifelong regime of dietary restrictions after undergoing bariatric surgery and get regular physical exercise.
''Patients must have a high level of self-discipline and be able to stick to the post-operative care plan for the rest of their lives,'' Dr Sutdhachit said. ''They really have to take this matter very seriously indeed.''
Three main types of bariatric surgery are offered in this country. The most common technique employed here is a gastric bypass (Roux-en-Y laparoscopic gastric bypass being the full medical term) in which the surgeon staples off a large section of the patient's stomach, leaving a tiny pouch to which the small intestine is re-routed.
Patients are physically unable to eat as much as they did before surgery. There is a quick onset of the sensation of fullness because their greatly reduced stomach space can only accommodate a tiny amount of food at one time.
While patients do subsequently lose a lot of weight, some run the risk of food-absorption problems and nutritional deficiencies as the first section of their small intestine, which produces acid to pre-digest food, is bypassed.
''Dietary therapy and vitamin intake are very important for patients who have undergone a gastric bypass,'' the surgeon said. The second most common procedure here is gastric banding (laparoscopic adjustable gastric banding).
It involves inserting a band around the upper part of the stomach in order to create a small pouch which can only hold a small amount of food. The band slows down the passage of food from the pouch to the remainder of the stomach. The advantage of this procedure is that it doesn't involve any trauma to or removal of parts of the digestive system, so it is unlikely to interfere with food absorption.
However, post-operative patients need to follow a strict diet and exercise programme in order to avoid piling on the weight again. A monthly visit to one's doctor is also required for band adjustments. And the possibility of health complications at a later point can be high.
''Gastric banding may be the least invasive and the safest weight-loss procedure, but many young patients tend to worry about the quality of the materials used to make the band and its long-term maintenance,'' said Dr Sutdhachit.
The third procedure is a lot more drastic. Termed a vertical sleeve gastrectomy, it involves the permanent reduction of the size of the stomach. This is done by removing a large portion of the organ and then forming a tube or ''sleeve'' which is roughly the shape of a banana.
This procedure is often done in combination with a gastric bypass. In high-risk cases, the gastric sleeve may be created first and after the patient has shed a good deal of excessive weight, the second step, the gastric bypass, can be performed. A bypass may not be needed, however, if the patient is satisfied with the results of the initial surgery.
''The gastric sleeve is now accepted as a stand-alone weight-loss procedure since it gives good results in some patients,'' Dr Sutdhachit noted.
Asian people who have a BMI of 37, or higher, meet the criteria for consideration for bariatric surgery. But even those with a BMI of 32 can be candidates for one of these procedures if they suffer from one or more related co-morbid conditions. The ideal age range for such surgery is between 16 and 65 years.
There are currently in the region of 100,000 obese or morbidly obese Thais who may need recourse to some form of bariatric surgery.
''Choosing good candidates and evaluating patients for weight-loss surgery can be challenging,'' said Dr Sutdhachit, who has performed about 300 such procedures over the past eight years.
''About 40% of my patients don't fit the bill; I didn't recommend surgery for them because they weren't sure whether they'd be able to change their lifestyles and stick to new eating habits.''
All forms of bariatric surgery pose serious risks, side-effects and complications, Dr Sutdhachit warned, adding that he always advises people who are considering such a move to research the procedure thoroughly and familiarise themselves with the post-operative regime that they will be required to follow.
''Study the matter well and talk to your doctor,'' he said. ''The doctor and the patient should reach a decision together on which procedure is best suited to the patient's situation.''
Kanyarin, the wedding planner, ultimately elected to have a vertical sleeve gastrectomy _ which, she enthused, has proved a great success. In the two years following the operation she managed to gradually shed a staggering 30kg. She currently weighs in at 54kg and says she is eating a lot less than before.
''Now I feel I've had enough after only five mouthfuls of food,'' she said. ''I had a fried mackerel for breakfast today. Then I had a bowl of noodles for lunch, but I only ate the meat balls and vegetables [leaving the starchy noodles untouched].
''I watch my weight very carefully these days. I go for healthier food choices and I'm a lot more active that I used to be in the past.''
One of the first things Kanyarin did after making the decision to undergo surgery was to go out and buy herself a gift, part reward and part incentive: a pair of smart, high-heeled shoes for future use.
''Now that I'm so much lighter, I feel like I'm living in a totally different world,'' she said. ''I wake up with a smile on my face every day. I feel good about my body and myself. I respect myself more.''
Helping your children make healthy food choices
The number of overweight and obese Thai children and teens is on the increase.
According to the Department of Health, the figure for obese six to 14 year olds increased by 10% in 1995 and by 15% in 2003, while there was also a steady rise in the incidence of obesity in the 13-18 age bracket. And health officials predict the percentages for both groups will continue to rise.
A study on child nutrition carried out by the department found the majority of six to 14 year olds surveyed admitted to consuming fast food, sweets and snacks and drinking carbonated or sugary drinks every day or almost every day.
Sujit Saleepun, a senior nutritionist at the department, blames the increase in the number of obese Thais on lifestyle changes brought about by urbanisation.
She noted that while predisposition to obesity can be an inherited condition _ most obese children have obese parents _ it is unhealthy eating habits and poorly balanced diets that are the main causes of obesity in this country.
"People's lives have got busier so they are much less inclined to cook for themselves. They go for fast food or eat a quick meal bought at a convenience store. They also tend to eat less vegetables and fruit," Sujit said. "Parents who eat unhealthy food, feed their children the same diet."
Sujit noted that Thai people consume an average of 20 teaspoonfuls of sugar per day, which is triple the daily recommended intake.
She recommends that children aged six to 13 who consume an average of 1,600 calories per day should limit their daily sugar intake to 16g, or four teaspoons; that adults (male and female) on a 2,000-calorie-a-day diet should limit themselves to about 24g (around six teaspoons) of sugar a day.
Farmers and athletes, whose exertions mean that they need at least 2,400 calories a day for sustenance, should use no more than 32g (around eight teaspoons) of sugar a day.
"We already get sugar from natural sources in our daily diet. This diet also provides us with other important nutrients. Sugary snacks and drinks are high in calories, but they don't supply nutrients to our bodies," she said. "When people consume a large amount of sugar-loaded food and drinks over time, they end up storing this in the form of fat, which leads to obesity."
Apart from unhealthy food choices, people nowadays tend to be very sedentary, with many spending most of their free time playing computer games, watching television or talking on the phone. And a lack of exercise can contribute to the problem of weight gain.
State nutritionist Sujit Saleepun has some tips:
- Make sure your children get a healthy breakfast since this is the most important meal of the day.
- Place limits on the amount of carbonated drinks and fast food your children can have.
- Make healthy food and beverage choices for them.
- Increase the vegetable and fruit content of their meals.
- Talk to them every evening to find out what they had to eat and drink at school that day. Educate them about what kinds of foods are beneficial so that they will be able to make healthy choices for themselves.
- Encourage them to be physically active and to take lots of exercise. Walking can be an excellent form of workout.
